Yes, There's a Medical Reason Some Narcotics Don't Work on Some People
New member here, and I am so sorry if this post is miscategorized! I just have a question about the two drugs in the title. Long story short, I had a tooth pulled and my dentist prescribed Lortab 5/500. One didn't do squat, so I took 1.5 and ultimately 2. I was starting to get a tiny bit of relief, but I don't like taking that much Tylenol. The same thing happened after the birth of my third child when my dr. gave me Darvocet. Anyway, my dentist called in a prescription for me for a drug called Fiorinal 3 with codeine. I know absolutely nothing about this med but I tried it anyway because on top of the pain, I had also gotten an infection in the socket. This drug did **nothing** for me. I was going to take another one, but I'm sort of a chicken when I comes to stuff like that, lol. My questions are a) has anyone ever heard of a case where narcotics just don't work for people; and b) is it safe to take more than one Fiorinal 3? I don't have much experience with narcotics really. THe only two I've ever taken that did anything for me were morphine (after a surgery I had years ago), and Stadol (my dr. gave me a small dose of it in my epidural when my first son was born). Holy crap--Stadol is some goooood stuff. Does anyone know why some narcotic would work and others wouldn't?
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EXCUSE TYPOS - VERY SLEEPY TODAY!
There are several reasons for certain narcotics not working on certain people, or in certain cases but it's very complex. I will try to explain a little bit of it to give you an idea.
Narcotics are processed, metabolized by the P450 class of enzymes, broken down into categories of different CYP enzymes, each with different names, acting on different medications. While the enzymes CYP2C9 and 2C19 are assigned to break down NSAIDS like Advil, and 2E1 breaks down Tylenol, most opiates (the ones that are classified as "prodrugs") are metabolized by the liver's CYP2D6 enzyme. Some people are born with genetic anomalies, such as an extra allele producing a higher than normal amount of this "drug eating" enzyme, dramatically affecting the usefulness of the drug. In other people with genetic 2D6 anomalies, they don't produce any, or they produce TONS of the "drug eating" enzyme. Each different situation will make the drug work differently. It's better explained in lay terms in this chart:
http://youscript.com/healthcare-professionals/why-youscript/genetic-variations-and-drug-metabolism/
Barbiturate drugs and prodrugs are metabolized by the CYP3A4 enzyme. If a patient doesn't have normally functioning 3A4 enzymes, then the effects of that class of drugs will be different with them.
The relationship of these enzymes to these drugs are extremely important and can even be deadly if a doctor doesn't do what he is SUPPOSED to do and practice medicine - diagnose his patient's unique ability to respond to and metabolize certain medications! More than 99% of doctors don't mess with the science of finding out, and just lump all patients together, assuming that all patients react the exact same way to narcotics, that what works for one will work for another, never considering the very real and extremely important reality that failing to diagnose and prescribe accordingly can and
HAS LED TO DEATHS in breastfeeding infants whose mothers were Ultra Rapid Metabolizers and had not been tested or diagnosed.
What's even more complicated is that certain other medications can either inhibit or potentiate the production of certain enzymes. That's why we hear about one drug making another work better, or one drug making another work worse. That is because the "side" drug is screwing with the level of the enzyme responsible for managing the "good" drug. Prozac and make your body make MORE of the enzyme that eats up your opiate "good" drug, so taking them together can lead to a lesser effect or shortened effect. Prilosec can inhibit some enzymes responsible for breaking down certain barbituates, so taking them together can sometimes make your pain med work better, stronger, and longer - which is NOT always a good thing, guys.
Pain management involves a very
delicate, very
specific balance in the body and NO TWO PEOPLE ARE THE SAME. Drugs affect everyone differently, many times
through no fault of their own. They are NOT, or did not start out as, addicted or abusing, they are just naturally tolerant because their bodies produce too much enzyme and their doctors didn't bother finding out the proper way to treat them, which often LEADS to drug abuse and addiction. Or the patients don't metabolize a narcotic/prodrug drug properly to allow it to work at normal therapeutic levels. Etc. There are many reasons why blanket diagnoses and dosages DO NOT APPLY or are INEFFECTIVE. This is why PHARMACO-GENETIC testing and understanding by doctors is sooooooooooooo incredibly important. Otherwise, patients, or patients' nursing babies could die. Children can lose parents to overdose or addiction, spouses can lose their partners, employers can lose workers, and innocent drivers can be killed on highways and streets - all due to improper prescribing of narcotics to patients who are genetically unable to process those medicines correctly, but whose doctors never bothered to check.
NEVER, NEVER, NEVER consent to a certain program of drug treatment therapy without INSISTING that your doctor customize your treatment plan according TO YOUR UNIQUE BODY and how your body processes toxic pharmaceuticals, which can ONLY be proven with blood testing for genetic and enzymatic markers.
More info:
http://youscript.com/healthcare-pro...netic-testing/cytochrome-p450-2d6-genotyping/
http://youscript.com/healthcare-professionals/why-youscript/dosing-recommendations/
http://www.clinchem.org/content/44/5/914.full
http://www.questdiagnostics.com/testcenter/testguide.action?dc=TS_PainMgmt